BVA9512878
DOCKET NO. 93-13 850 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in Chicago,
Illinois
THE ISSUE
Entitlement to an increased evaluation for hemorrhoids,
currently rated 20 percent disabling.
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
R. A. Caffery, Counsel
INTRODUCTION
The veteran served on active duty from January 1952 to
December 1953. This is an appeal from a January 1993 rating
action by the Department of Veterans Affairs (VA) Regional
Office, Chicago, Illinois, which confirmed and continued a
20 percent evaluation for the veteran's hemorrhoids. The
veteran has been recognized as permanently and totally
disabled and is in receipt of pension benefits based on his
non-service connected disabilities.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends, in substance, that increased evaluation
should be assigned for his hemorrhoids since he has constant
pain, and difficulty working, walking, sitting and sleeping
and especially during bowel movements. His prescribed warm
baths, cream ointments and other medication do very little to
reduce the pain he must endure. He wears pads due to the
constant bleeding.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter,
and for the following reasons and bases, it is the decision
of the Board that the preponderance of the evidence is
against the veteran's claim for an increased evaluation for
his hemorrhoids.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran's appeal has been obtained by the
regional office.
2. The veteran has several hemorrhoids that are inflamed and
thrombosed. There is some bleeding and leakage.
3. The veteran’s hemorrhoids have not resulted in extensive
leakage or occasional involuntary bowel movements
necessitating wearing of a pad.
CONCLUSION OF LAW
An evaluation in excess of 20 percent for the veteran's
hemorrhoids is not warranted. 38 U.S.C.A. §§ 1155, 5107
(West 1991); 38 C.F.R. Part 4, Codes 7332, 7336, 7337 (1994).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The Board notes that it has found the veteran's claim to be
"well grounded" within the meaning of 38 U.S.C.A. § 5107(a)
(West 1991); effective on and after September 1, 1989. That
is, the Board finds that he has presented a claim which is
plausible. The Board is also satisfied that all relevant
facts have been properly developed.
I. Background
The veteran's service medical records reflect that in
April 1953 various conditions were noted including external
hemorrhoids and an anal fissure. In November 1953 pruritus
ani with perianal eczema was noted.
By rating action dated in April 1972, service connection was
granted for external hemorrhoids with an anal fissure, rated
noncompensable.
When the veteran was examined by the VA in August 1972
pruritus ani with moderate perianal eczema and internal and
external hemorrhoids were reported.
In an August 1972 rating action, the evaluation for the
veteran's hemorrhoids was increased from noncompensable to
10 percent.
When the veteran was examined by the VA in February 1988
external hemorrhoids were noted. The diagnoses included
hemorrhoids with pruritus ani and a duodenal ulcer.
When the veteran was examined by the VA in September 1990 he
indicated that he used a rectal ointment and was taking a
laxative and hot sitz baths. He noticed bleeding on bowel
movements.
On physical examination there were severe thrombosed external
hemorrhoids with pruritus and proctitis and rectal fissure.
Internal hemorrhoids were also noted that were tender to
touch.
By rating action dated in October 1990, the evaluation for
the veteran's hemorrhoids was increased from 10 percent to
20 percent.
The veteran was again examined by the VA in December 1992.
He reported that he had soiling of his underwear with blood
and feces at times. He indicated that he had diarrhea on
occasion and on occasion lost control. He reported that the
hemorrhoids became inflamed frequently. On examination there
were three hemorrhoids that were severely inflamed and
thrombosed.
II. Analysis
A 10 percent evaluation is warranted for large or thrombotic,
irreducible, external or internal hemorrhoids with excessive
redundant tissue evidencing frequent recurrences. A
20 percent evaluation requires hemorrhoids with persistent
bleeding and secondary anemia with fissures. 38 C.F.R.
Part 4, Code 7336.
Pruritus ani is evaluated on the basis of the underlying
condition. 38 C.F.R. Part 4, Code 7337.
A 10 percent evaluation is warranted for impairment of the
rectal and anal sphincter with constant slight leakage or
occasional moderate leakage. A 30 percent evaluation is
appropriate if the impairment is manifested by occasional
involuntary bowel movements which necessitate the wearing of
a pad. A 60 percent evaluation is appropriate if there are
extensive leakage and fairly frequent involuntary bowel
movements. 38 C.F.R. Part 4, Code 7332.
In this particular case, the record reflects that the veteran
has several hemorrhoids that are severely inflamed and
thrombosed. He also experiences rectal bleeding as a result
of the hemorrhoids. However, he is currently receiving the
maximum 20 percent evaluation under Diagnostic Code 7336 for
hemorrhoids. Although the veteran has indicated that he has
occasional diarrhea and incontinence, it has not been
established that those conditions have resulted from his
service-connected hemorrhoids. He has not reported that he
needs to use a pad to control bowel movements. Accordingly,
under the circumstances of this case, the Board is unable to
conclude that the requirements for an evaluation, under any
applicable code, in excess of that currently in effect for
the veteran's hemorrhoids have been demonstrated.
In reaching its decision, the Board has considered the
complete history of the disability in question as well as the
current clinical manifestations and the effect the disability
may have on the earning capacity of the veteran. 38 C.F.R.
§§ 4.1, 4.2, 4.41. The nature of the original condition has
been reviewed and the functional impairment which can be
attributed to pain or weakness has been taken into account.
38 C.F.R. § 4.40. Further, the Board finds that in this case
the disability picture is not so exceptional or unusual so as
to warrant an evaluation on an extraschedular basis. It has
not been shown that the hemorrhoids have caused marked
interference with employment or necessitated frequent periods
of hospitalization. 38 C.F.R. § 3.321(b)(1). The criteria
for an evaluation greater than 20 percent for the hemorrhoids
have not been approximated. 38 C.F.R. § 4.7. The Board does
not find the evidence to be so evenly balanced in this case
that there is doubt as to any material issue. 38 U.S.C.A.
§ 5107.
ORDER
Entitlement to an increased evaluation for hemorrhoids,
currently rated 20 percent disabling is not established. The
appeal is denied.
ROBERT D. PHILIPP
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on appeal
is appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the agency
of original jurisdiction on or after November 18, 1988.
Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402
(1988). The date which appears on the face of this decision
constitutes the date of mailing and the copy of this decision
which you have received is your notice of the action taken on
your appeal by the Board of Veterans' Appeals.